<div class="queryBox">
 <table>
  <tr>
   <td colspan="1" class="queryHCell">
    <strong class="colorBlue font12">
     Prosimy o podanie numeru telefonu na który oczekują państwo kontaktu (do 48h).
	</strong>
   </td>
  </tr>
  <tr>
   <td colspan="1" class="queryCell">
    <p class="colorBlue font12">
     <label>imię i nazwisko:</label>
    </p>
   </td>
  </tr>
  <tr>
   <td colspan="1" class="queryFormCell">
    <p class="colorBlack font12">
	 <?php echo $this->formText('name', null, array('class' => 'formText', 'tabindex' => '1')); ?>
    </p>
   </td>
  </tr>  
  <tr>
   <td colspan="1" class="queryCell">
    <p class="colorBlue font12">
     <label>e-mail:</label>
    </p>
   </td>
  </tr>
  <tr>
   <td colspan="1" class="queryFormCell">
    <p class="colorBlack font12">
	 <?php echo $this->formText('email', null, array('class' => 'formText', 'tabindex' => '1')); ?>
    </p>
   </td>
  </tr>
  <tr>
   <td colspan="1" class="queryCell">
    <p class="colorBlue font12">
     <label>telefon:</label>
    </p>
   </td>
  </tr>
  <tr>
   <td colspan="1" class="queryFormCell">
    <p class="colorBlack font12">
	 <?php echo $this->formText('telephone', null, array('class' => 'formTextSmall', 'tabindex' => '2')); ?>
    </p>
   </td>
  </tr>
  <tr>
   <td colspan="1" class="queryCell">
    <p class="colorBlue font12">
     <label>wiadomość:</label>
    </p>
   </td>
  </tr>
  <tr>
   <td colspan="1" class="queryFormCell">
    <p class="colorBlack font12">
	 <?php echo $this->formTextarea('message', null, array('class' => 'formTextArea', 'tabindex' => '3')); ?>
    </p>
   </td>
  </tr>
  <tr>
   <td colspan="1" class="queryButtonCell">
    <p class="colorBlack font12">
	 <?php echo $this->formImage('send', 'Wyślij', array('class' => 'formTextArea', 'tabindex' => '4', 'src' => $this->baseUrl.'/public/images/small_btn_bckg.png' )); ?>
    </p>
   </td>
  </tr>
 </table>
<?php echo $this->formHidden('baseUrl', $this->baseUrl, null); ?> 
</div>
<div class="messageBox">
 <div class="messageCanvas">
 </div>
</div>